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A Practitioners' Guide by Noam Tyrolerwww.thaiacu.com

THAI M ASSAGE TECHNIQUESFor Pregnancy, Labor & Postpartum

The School of Thai Acupressure's Collection of Treatment Protocols for Common Pregnancy & Postpartum

Complaints & Discomforts

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What is pregnancy heartburn? • Many women experience heartburn for the first time during pregnancy. Although it is harmless, it can be quite

uncomfortable, disturb sleep, may become painful, and trigger vomiting.• Heartburn (Acid reflux) is a pain or a burning sensation that rises from the stomach through the chest to the

throat. This happens when stomach acids rise into the esophagus. The esophagus is the muscular tube that allows food to travel from the mouth to the stomach. Heartburn is worse when lying down.

• According to a heartburn prevalence study with 607 women, 22% experienced heartburn during the 1st trimester, 39% during the 2nd trimester and 72% during the 3rd trimester.

• The common belief that symptoms decrease in the last weeks of pregnancy has not been observed.

Possible causes• The pregnancy-induced fluctuations in progesterone (and also estrogen) trigger heartburn.• Progesterone slows down digestion, causing the stomach to produce less digestive acids. Less stomach acids

(though it may seem counterintuitive) slows down digestion, creating acid reflux. • Progesterone inhibits uterine contractions during pregnancy and relaxes the smooth muscle in the uterus. This

allow it to grow to accommodate the baby. This process is not selective and relaxes other smooth muscles and tissues in the body. It also relaxes the valve (esophageal sphincter) at the lower end of the esophagus that keeps digestive acids in the stomach, allowing acid reflux to occur.

• Later in pregnancy, the growing baby compresses the stomach, pushing stomach acid and possibly under-digested content back up into the esophagus.

TCM point of view• One can view pregnancy heartburn as difficulty of the digestive track to keep its natural flow downward, due to

an upward flow of blood to the breast for the creation of milk. • Additional factors are a natural increase of heat in the pregnant body together with excessive emotional stress

and acidity in the upper abdomen and chest.

Some advice• Correct diet and eating habits are necessary. Eat small meals and sit straight. Try to make your main meal

at lunchtime. Try to avoid eating a couple hours before going to bed. Chew slowly. Sip water and liquids throughout the day, but avoid liquids while you eat. This dilutes your digestive juices. Do not lay down after a meal, but take a walk instead. Avoid tight fitting clothes that puts even more pressure on your stomach.

• Avoid fatty, fried, hot, acidic foods including: Alcohol, sugar, coffee, chocolate, onions, tomatoes, citrus fruits, mustard and large quantities of meat that may takes hours to digest. Iron supplements can cause heartburn.

• Eat alkalizing foods that help prevent heartburn: Cucumber, almonds, avocado and most vegetable, particularly green papaya, fresh ginger and fermented foods (raw sauerkraut, kim chi, kefir).

• Drink raw apple cider vinegar (1-2 teaspoon vinegar with 1 cup water). Sip throughout the day and an hour before meals), fresh lemon in water, coconut water and yogurt. Drink ginger, fennel, anise, peppermint and chamomile teas.

• Use orange, bergamote, and or lavender oils mixed or single in an evaporator or 2 drops of each in 1 tablespoon of almond oil and apply on acupressure points Ren -12 and Ren - 6.

• Sleep with your torso propped up on folded blankets or hard pillows.

General instructions:• In your treatment, use pressure and stretches to create more space for the stomach by working the middle

back, belly, ribs cage and shoulder girdle. Use twists to work the middle back, ribs cage and “stomach belt”. Use extensions to stretch the front middle line from the throat to the pubic bone. Use tractions to stretch the torso away from the lower body.

• Focus on the prescribed lines and points to release the “stomach belt”, encourage a downward flow in the digestive track and to release excess chest and abdominal emotional stress, heat and acidity.

• Your treatment will relieve the symptoms for a week or so. Your client will need a weekly treatment to relieve the increasing pressure on the stomach put by the growing baby.

HEARTBURN1st, 2nd and 3rd trimesters

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Yoga poses:Use Thai massage postures, stretches and acupressure that are inspired by these Yoga AsanasThese asanas may be performed only under the permission, guidance and support of a Yoga teacher.

KID-1 A usually very pleasant, relaxing point at the sole of the foot, in a depression

immediately posterior to the 3rd toe metatarsophalangeal joint

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1. Give her a foot massage and thumb press points 1 and 2

Press between 5-15 seconds and release pressure. Repeat 1-3 times. Use the amount of pressure that suits her. Work the foot diaphragm area.

Inner foot-7 (SP-4)2 fingers anterior to Inner ankle • below the base of the 1st metatarsal bone

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SUPINE POSITION

2. Palm press her inner leg and focus on the 1st line (SP)

Use your body weight as you start at the foot, work up to the groin and back down. Repeat 1-3 times.

Steps 1-2, p.80

legs up the wall pose

Reclining bound angle pose

Reclining cross-legged pose

Reclining hero pose

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6. Give her a chest massage

Use gentle techniques that you are familiar with or follow the instructions. Focus on massaging and introducing movement to the ribs cage especially its lower half. Gently stroke the 2 sides of the xiphoid process down 10-20 times. Work on the skin level.Steps 1-4, p.102-103

7. Try these stretches

Use the range of twist that suits her. Pull her lower back with your hands or with a towel to bring her to a mild Yoga bridge pose and gently rock her.

Steps 24-25, p.86-87

Steps 1-3, p.96P.120,121

8. Palm press her inner arm and thumb press Mid-in-arm line (PC)

Use your body weight as you start at the wrist and palm press up to the armpit and back down. Repeat 1-3 times. Now, thumb press Mid-in-arm line up and down and repeat 1-3 times.

5. Give her a gentle abdominal massage

Use your full hand to pull and push down and up, from side to side but do not press on the belly

directly and do not use penetrating pressure.Focus on gently pulling the belly down and away from the ribs cage. Steps 1-2, p.98-99

3. Palm press her outer leg and thumb press lines 1 and 2 (ST)

Start at the foot, palm press up to the hip and back down. Repeat 1-3 times. Now, thumb press up and down and repeat 1-3 times.

4. Thumb press points 3-5

Press between 5-15 seconds. Release pressure. Repeat 1-3 times. Use the amount of pressure that suits her.

Steps 1-3, p.84

Leg 2nd outer line-3 (ST-36)4 fingers below the lower border of the patella • on the tibialis anterior

muscle, about 1 finger lateral to the tibia crest • radiates to the foot

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(ST-37)1 finger width from the anterior crest

of the tibia • 6 fingers below the patella. press on tibialis anterior

Leg 2nd outer line-5 (ST-34)2 fingers above the patella • in a shallow depression between the

muscles rectus femoris and vastus lateralis • or alternatively, just

anterior to the iliotibial tract

Steps 1+3, p.110

Heartburn

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9. Thumb press point 6 and 7

Press between 5-15 seconds and release pressure. Repeat 1-3 times. Use the amount of pressure that suits her.

PC -6In the depression between the two tendons • 2 fingers above the wrist

PC -45 fingers above the wrist between the palmaris longus and flexor carpi radialis tendons6

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12. Try all shoulder and shoulder blade mobilizations and stretches

11. Thumb press points 8-10

Use your thumb to gradually build pressure on the point. Press for 5-15 seconds. Release pressure and repeat once or twice. Use the amount of pressure that suits your client.

Ancient point 10

(BL-17) 1.5 fingers lateral to the gap between the spinous processes of T- 7 and T-8 • just above the level of the lower tip of the scapula • on the highest point of the paraspinal muscles

When heartburn

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2nd back-13 (Weiguanxiashu)1.5 fingers lateral to the spinous process of T-8 • below the level of the lower angle of the scapula • on the highest point of the paraspinal muscles

2nd back-14 (BL-18)1.5 fingers lateral to the spinous process of T-9 • 2 fingers below the lower angle of the scapula • on the highest point of the paraspinal muscles

SIDE POSITION

10. Palm press her back and thumb press the 3 back lines (Jiaji, BL1&2)

Palm press from the sacrum up to C-7 and back down. Repeat 1-3 times. Now thumb press the lines up and down and repeat once or twice.

Steps 1-4, p.152-154

Steps 4-14 p.158-162

Heartburn

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15. Try these stretches

Stop when she dislike a stretch.

13. Try these stretches

Work slowly and gently when applying stretches. Only use stretches which are comfortable for her.

Steps 1-6, p.180-182

SUPINE POSITION

SITTING POSITION

14. Try these stretches

Work slowly and gently when applying the stretches. Stop if a stretch is uncomfortable for her.

Steps 1, 6, 7, 8 p.202-205

Steps 5, 7, 8, 9 p.210-212

Steps 13-26 p.216-219

Heartburn

ISBN 978-965-92242-7-2

9 789659 224272

Thai massage is the ideal, manual method that a woman can hope for in pregnancy, in the birthing room, and in the months that follow birth. The line work, the pressure of key points, squeezing, rotating, mobilizations, and especially the stretches and Yoga- like postures are exactly what she needs.

I was lucky to treat many pregnant women before ever learning of the many limitations that I am “supposed” to put on the treatment session. My experience has taught me that most pregnancy massage "formal" limitations are far too exaggerated.

This guidebook was written to encourage you to put fewer limitations on your treatment and to use as many as the wonderful and effective Thai massage techniques and postures, as long as they feel appropriate to you and as long as your pregnant client likes them.

This guidebook presents 25 treatment routines for common pregnancy, labor and postpartum discomforts. The original version of these routines were put together in 2003 by me, Eran Goldstein, and Idit Tyroler. This content was part of a thesis that Eran and Idit were writing at the end of their “Dula” (labor companion) course. This thesis was used as a manual in the pregnancy massage workshops for my students in Israel. I revised these routines with Motke Eilon for this new edition.

These are not traditional Thai massage treatment routines. We are the originators of this collection of treatment protocols. The pressure techniques and stretches, however, are all taken from Thai massage.

With my Daughter Gal, first time at the beach , April 2002

Treatment routines for common complaints of pregnancy, labor and postpartum

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Painful period / Menstrual cramps 224

Insomnia 236

Stress, Anxiety and mood swings 242

Frequent and urgent urination 250

Nausea / Morning sickness 256

Exhaustion / Fatigue 264

Constipation 270

Abdominal pain 276

Heartburn 282

Nasal congestion, snoring and nose bleeds 288

Shortness of breath / Suffocation 296

Edema / Swelling 304

Hemorrhoid / Pile / Varicose veins 312

Anemia 318

Dizziness, fainting and blurred vision 324

Itchiness, rashes, red palms and soles of feet 334

Headache 340

Cough 348

Lower back and pelvic girdle pain (PGP) 356

Preparation for labor, pre-birth treatment 364

Getting ready for labor 372

In the birthing room 374

Postpartum 390

Inconsistent flow of breast milk 394

Abdominal pain after birth 406

Baby blues / Postpartum depression 412

Constipation after childbirth 422

Acupressure points 432

Labor-inducing points 444

Points to avoid during pregnancy 446